Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Rosamond L. Naylor
Roz Naylor
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Read the original post on Medium.com:

A Global Perspective on Food Policy

I applaud Mark Bittman, Michael Pollan, Ricardo Salvador, and Olivier de Schutter for advocating the introduction of a national food policy in the U.S. Greater emphasis in our current farm legislation on nutrition, health, equity, and the environment is clearly warranted and long overdue. As the authors note, Americans’ access to adequate nutrition at all income levels affects educational and health outcomes for the nation as a whole. Poor nutrition thus plays a role in determining the level and distribution of economic and social wellbeing in the U.S, now and in the future. It is surprising that no one within the large circle of Presidential hopefuls has raised the topic of food, not just agriculture, as a major political issue for the 2016 election.

The U.S. is not unique. Virtually every country with an agrarian base has, at some point in history, introduced agricultural policies that support farmers and provide incentives for them to produce major commodities. At the time, governments have been able to justify these policies on several grounds: national security (avoiding excess dependence on foreign nations for food), economic growth (using agricultural surpluses as an engine of economic growth), and social stability (keeping its population well-fed to avoid social unrest). Once agricultural policies are implemented, they typically give rise to institutions and vested political interests that perpetuate a supply-side orientation to food and agriculture. In the U.S., the political institutions that govern food and agriculture have their roots in historical political precedents that date back to the 1860s, and later to the 1930s when the New Deal was promulgated. Farm interests have been entrenched in the U.S. political system for quite some time, and they cannot be easily removed.

There is a general rule for successful policies: Align incentives with objectives. A corollary to this principle is that objectives change over the course of economic development. For the United States in earlier eras, and for many developing economies in recent decades, meeting basic calorie needs has been the first order of business. This objective has been largely achieved through public investments in infrastructure (irrigation, roads), research and development, commodity support programs, incentives for private agribusiness development, and other supply-side measures.

With successful agricultural growth and rising incomes, many countries face a new set of food and nutrition challenges: eliminating “hidden hunger” (deficiencies in iron, vitamin A, calcium, zinc and other micronutrients), and abating the steady rise in obesity that results from a transition to diets rich in energy-dense carbohydrates, fats, and sugar. Hidden hunger affects some three billion people worldwide. It is prevalent among low-income households in almost all countries, impairs cognitive and physical development (especially among infants up to two years of age) and thus limits a nation’s educational and economic potential. Meanwhile, rates of obesity now surpass rates of energy-deficient hunger throughout the world, even in developing nations.

The objectives of food and agricultural policies in virtually all countries need to shift, on balance, from promoting staple food supplies to enhancing nutrition. I am not suggesting an abandonment of agriculture, but rather an enrichment of agriculture with more crop diversity to support the nutritional needs of all people. If improved nutrition is the objective, what are the correct incentives? Proper incentives will differ among countries, but will inevitably require a fundamental change in institutional structure. With a shift from supply- to demand orientation, there needs to be a transition from Ministries of Agriculture to Ministries of Food. After all, the main goals of a Ministry of Agriculture are to increase the volume of agricultural production and to improve economic growth in the agricultural sector. The main goal of a Ministry of Food, by contrast, is to enhance the nutrition and food security of the entire population.

Bittman, Pollan, Salvador, and de Schutter emphasize that replacing the U.S. Department of Agriculture (USDA) with a “U.S. Department of Food, Health, and Wellbeing” would be difficult at best. It would require unprecedented political will and cooperation among parties. The same can be said for institutional change in agricultural ministries throughout the world. Regardless of the challenges, however, nothing will change until the conversation surrounding food policies, politics, and institutions takes a major turn.

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More than 46 million Americans live in poverty and high rates of food insecurity and obesity are also a persistent concern. The Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, occupies a central role in the U.S. safety net as the only universal aid program for low income individuals. In this talk, Professor Hilary Hoynes will review the evidence on the two  goals of SNAP: providing income support and improving nutrition. Professor Hoynes will discuss the trends in poverty and inequality in the U.S, and how SNAP affects poverty overall and particularly in the Great Recession. Additionally, she will review the evidence on the impact of SNAP on food insecurity and health. This will include new evidence on how access to social safety net programs in early life affect health and human capital outcomes in adulthood. 


Hilary Hoynes is a Professor of Public Policy and Economics and holds the Haas Distinguished Chair in Economic Disparities. She is the co-editor of the leading journal in economics, American Economic Review. Hoynes received her undergraduate degree from Colby College and her PhD from Stanford University.

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Hilary Hoynes

Hoynes is an economist and specializes in the study of poverty, inequality, and the impacts of government tax and transfer programs on low income families. Current projects include evaluating the impact of the Great Recession across demographic groups, examining the impact of Head Start on cognitive and non-cognitive outcomes, examining the impact of the Earned Income Tax Credit on infant health, and estimating impacts of U.S. food and nutrition programs on labor supply, health and human capital accumulation.

In addition to her faculty appointment, Hoynes has research affiliations at the National Bureau of Economic Research, the UC Davis Center for Poverty Research and the Institute for Fiscal Studies. She sits on the Advisory Board of the Stanford Institute for Economic Policy Research and previously has sat on the National Advisory Committee of the Robert Wood Johnson Foundation Scholars in Health Policy Research Program and the Advisory Committee for the National Science Foundation, Directorate for the Social, Behavioral, and Economic Sciences. Prior to joining the Goldman School she was a Professor of Economics at UC Davis.

Hilary Hoynes Professor of public policy and economics; Haas Distinguished Chair in Economic Disparities, UC Berkeley
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Bad weather in sub-Saharan Africa increases the spread of HIV, according to a study published in the June 2015 issue of the Economic Journal, co-authored by Stanford professor and FSE fellow Marshall Burke.

When the rains fail, farmers in rural areas often see their incomes fall dramatically and will try to make up for it however they can, including through sex work. Analysing data on more than 200,000 individuals across 19 African countries, the research team finds that by changing sexual behaviour, a year of very low rainfall can increase local infection rates by more than 10%.

The results have important policy implications for fighting the spread of the epidemic, as co-author Erick Gong of Middlebury College notes:

‘Existing approaches to stopping the spread of HIV – such as promoting condom use and the use of anti-retrovirals – remain critically important. But our results suggest that other policy approaches could be very useful too – in particular, approaches that provide safety nets to rural households when the weather turns bad.’

Policies and investments seemingly unrelated to HIV – such as the promotion of rural insurance or household savings schemes, or the development of drought-tolerant crops – might have surprising benefits in slowing the HIV epidemic. Co-author Kelly Jones of the International Food Policy Research Institute says:

‘The HIV/AIDS epidemic remains one of the world’s greatest health challenges, with over a million new infections per year in Africa alone. Our results expand the menu of options for addressing the epidemic, and highlight some surprising options that are not at the forefront of people’s minds.’

The research sheds valuable light on why HIV continues to spread in Africa. Previous studies have documented in limited settings that poor women often alter their sexual behaviour in response to an income shortfall. But until now, there has been little evidence that this response is big enough to affect the trajectory of the HIV epidemic.

To fill this gap, the researchers combined data on the HIV status of thousands of people across sub-Saharan Africa with data on the recent rainfall history in each individual’s location.

Because years of low rainfall can lead to much lower incomes in these locations, particularly in rural areas where people depend more heavily on agriculture for their livelihoods, variation in rainfall provides a way to study how changes in local economic conditions affect infection rates. Co-author Marshall Burke comments:

‘We were surprised by how strong the relationship is between recent rainfall fluctuations and local infection rates. As expected, the relationship is much stronger in rural areas, and particularly for women who report working in agriculture. These are the people who really suffer when the rains fail, and who are forced to turn to more desperate measures to make ends meet.’

Notes for editors: ‘Income Shocks and HIV in Africa’ by Marshall Burke, Erick Gong and Kelly Jones is published in the June 2015 issue of the Economic Journal.

Marshall Burke is an assistant professor of Earth System Science at Stanford University. Erick Gong is an assistant professor of economics at Middlebury College. Kelly Jones is a research fellow at the International Food Policy Research Institute (IFPRI).

For further information: contact Marshall Burke on +1-650-736-8571 (email: mburke@stanford.edu); Erick Gong on +1-802-443-5553 (email: egong@middlebury.edu); Kelly Jones on +1-202-862-4641 (email: k.jones@cgiar.org); or Romesh Vaitilingam on +44-7768-661095 (email: romesh@vaitilingam.com; Twitter: @econromesh).

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Jennifer Burney
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A new study by Center on Food Security and the Environment researchers finds that smallholder irrigation systems - those in which water access (via pump or human power), distribution (furrow, watering can, sprinkler, drip lines, etc.), and use all occur at or near the same location - have great potential to reduce hunger, raise incomes and improve development prospects in an area of the world greatly in need of these advancements. Financing is crucial, as even the cheapest pumps can be prohibitively expensive otherwise.

These systems have the potential to use water more productively, improve nutritional outcomes and rural development, and narrow the income disparities that permit widespread hunger to persist despite economic advancement. Only 4 percent of agricultural land in sub-Saharan Africa is currently irrigated.

"Success stories can be found where distributed systems are used in a cooperative setting, permitting the sharing of knowledge, risk, credit and marketing as we've seen in our solar market garden project in Benin," said Jennifer Burney, lead author of the study published in the Proceedings of the National Academy of Sciences.

Moving forward development communities and sub-Saharan African governments need a better understanding of present water resources and how they will be affected by climate change.

"Farmers need access to financial services—credit and insurance—appropriate for a range of production systems," said co-author and Stanford Woods Institute Senior Fellow Rosamond Naylor. "Investments should start at a smaller scale, with thorough project evaluation, before scaling up."

FSE continues to contribute to these evaluations and added eight new villages to our project in Benin last year.

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For 14 years, Mariano-Florentino Cuéllar has been a tireless Stanford professor who has strengthened the fabric of university’s interdisciplinary nature. Joining the faculty at Stanford Law School in 2001, Cuéllar soon found a second home for himself at the Freeman Spogli for International Studies. He held various leadership roles throughout the institute for several years – including serving as co-director of the Center for International Security and Cooperation. He took the helm of FSI as the institute’s director in 2013, and oversaw a tremendous expansion of faculty, research activity and student engagement. 

An expert in administrative law, criminal law, international law, and executive power and legislation, Cuéllar is now taking on a new role. He leaves Stanford this month to serve as justice of the California Supreme Court and will be succeeded at FSI by Michael McFaul on Jan. 5.

 As the academic quarter comes to a close, Cuéllar took some time to discuss his achievements at FSI and the institute’s role on campus. And his 2014 Annual Letter and Report can be read here.

You’ve had an active 20 months as FSI’s director. But what do you feel are your major accomplishments? 

We started with a superb faculty and made it even stronger. We hired six new faculty members in areas ranging from health and drug policy to nuclear security to governance. We also strengthened our capacity to generate rigorous research on key global issues, including nuclear security, global poverty, cybersecurity, and health policy. Second, we developed our focus on teaching and education. Our new International Policy Implementation Lab brings faculty and students together to work on applied projects, like reducing air pollution in Bangladesh, and improving opportunities for rural schoolchildren in China.  We renewed FSI's focus on the Ford Dorsey Program in International Policy Studies, adding faculty and fellowships, and launched a new Stanford Global Student Fellows program to give Stanford students global experiences through research opportunities.   Third, we bolstered FSI's core infrastructure to support research and education, by improving the Institute's financial position and moving forward with plans to enhance the Encina complex that houses FSI.

Finally, we forged strong partnerships with critical allies across campus. The Graduate School of Business is our partner on a campus-wide Global Development and Poverty Initiative supporting new research to mitigate global poverty.  We've also worked with the Law School and the School of Engineering to help launch the new Stanford Cyber Initiative with $15 million in funding from the Hewlett Foundation. We are engaging more faculty with new health policy working groups launched with the School of Medicine and an international and comparative education venture with the Graduate School of Education. 

Those partnerships speak very strongly to the interdisciplinary nature of Stanford and FSI. How do these relationships reflect FSI's goals?

The genius of Stanford has been its investment in interdisciplinary institutions. FSI is one of the largest. We should be judged not only by what we do within our four walls, but by what activity we catalyze and support across campus. With the business school, we've launched the initiative to support research on global poverty across the university. This is a part of the SEED initiative of the business school and it is very complementary to our priorities on researching and understanding global poverty and how to alleviate. It's brought together researchers from the business school, from FSI, from the medical school, and from the economics department.  

Another example would be our health policy working groups with the School of Medicine. Here, we're leveraging FSI’s Center for Health Policy, which is a great joint venture and allows us to convene people who are interested in the implementation of healthcare reforms and compare the perspective and on why lifesaving interventions are not implemented in developing countries and how we can better manage biosecurity risks. These working groups are a forum for people to understand each other's research agendas, to collaborate on seeking funding and to engage students. 

I could tell a similar story about our Mexico Initiative.  We organize these groups so that they cut across generations of scholars so that they engage people who are experienced researchers but also new fellows, who are developing their own agenda for their careers. Sometimes it takes resources, sometimes it takes the engagement of people, but often what we've found at FSI is that by working together with some of our partners across the university, we have a more lasting impact.

Looking at a growing spectrum of global challenges, where would you like to see FSI increase its attention? 

FSI's faculty, students, staff, and space represent a unique resource to engage Stanford in taking on challenges like global hunger, infectious disease, forced migration, and weak institutions.  The  key breakthrough for FSI has been growing from its roots in international relations, geopolitics, and security to focusing on shared global challenges, of which four are at the core of our work: security, governance, international development, and  health. 

These issues cross borders. They are not the concern of any one country. 

Geopolitics remain important to the institute, and some critical and important work is going on at the Center for International Security and Cooperation to help us manage the threat of nuclear proliferation, for example. But even nuclear proliferation is an example of how the transnational issues cut across the international divide. Norms about law, the capacity of transnational criminal networks, smuggling rings, the use of information technology, cybersecurity threats – all of these factors can affect even a traditional geopolitical issue like nuclear proliferation. 

So I can see a research and education agenda focused on evolving transnational pressures that will affect humanity in years to come. How a child fares when she is growing up in Africa will depend at least as much on these shared global challenges involving hunger and poverty, health, security, the role of information technology and humanity as they will on traditional relations between governments, for instance. 

What are some concrete achievements that demonstrate how FSI has helped create an environment for policy decisions to be better understood and implemented?

We forged a productive collaboration with the U.N. High Commissioner for Refugees through a project on refugee settlements that convened architects, Stanford researchers, students and experienced humanitarian responders to improve the design of settlements that house refugees and are supposed to meet their human needs. That is now an ongoing effort at the UN Refugee Agency, which has also benefited from collaboration with us on data visualization and internship for Stanford students. 

Our faculty and fellows continue the Institute's longstanding research to improve security and educate policymakers. We sometimes play a role in Track II diplomacy on sensitive issues involving global security – including in South Asia and Northeast Asia.  Together with Hoover, We convened a first-ever cyber bootcamp to help legislative staff understand the Internet and its vulnerabilities. We have researchers who are in regular contact with policymakers working on understanding how governance failures can affect the world's ability to meet pressing health challenges, including infectious diseases, such as Ebola.

On issues of economic policy and development, our faculty convened a summit of Japanese prefectural officials work with the private sector to understand strategies to develop the Japanese economy.  

And we continued educating the next generation of leaders on global issues through the Draper Hills summer fellows program and our honors programs in security and in democracy and the rule of law. 

How do you see FSI’s role as one of Stanford’s independent laboratories?

It's important to recognize that FSI's growth comes at particularly interesting time in the history of higher education – where universities are under pressure, where the question of how best to advance human knowledge is a very hotly debated question, where universities are diverging from each other in some ways and where we all have to ask ourselves how best to be faithful to our mission but to innovate. And in that respect, FSI is a laboratory. It is an experimental venture that can help us to understand how a university like Stanford can organize itself to advance the mission of many units, that's the partnership point, but to do so in a somewhat different way with a deep engagement to practicality and to the current challenges facing the world without abandoning a similarly deep commitment to theory, empirical investigation, and rigorous scholarship.

What have you learned from your time at Stanford and as director of FSI that will inform and influence how you approach your role on the state’s highest court?

Universities play an essential role in human wellbeing because they help us advance knowledge and prepare leaders for a difficult world. To do this, universities need to be islands of integrity, they need to be engaged enough with the outside world to understand it but removed enough from it to keep to the special rules that are necessary to advance the university's mission. 

Some of these challenges are also reflected in the role of courts. They also need to be islands of integrity in a tumultuous world, and they require fidelity to high standards to protect the rights of the public and to implement laws fairly and equally.  

This takes constant vigilance, commitment to principle, and a practical understanding of how the world works. It takes a combination of humility and determination. It requires listening carefully, it requires being decisive and it requires understanding that when it's part of a journey that allows for discovery but also requires deep understanding of the past.

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In a recent speech, Stanford professor Rosamond Naylor examined the wide range of challenges contributing to global food insecurity, which Naylor defined as a lack of plentiful, nutritious and affordable food. Naylor's lecture, titled "Feeding the World in the 21st Century," was part of the quarterly Earth Matters series sponsored by Stanford Continuing Studies and the Stanford School of Earth Sciences. Naylor, a professor of Environmental Earth System Science and director of the Center on Food Security and the Environment at Stanford, is also a professor (by courtesy) of Economics, and the William Wrigley Senior Fellow at the Freeman Spogli Institute for International Studies and the Stanford Woods Institute for the Environment.

"One billion people go to bed day in and day out with chronic hunger," said Naylor. The problem of food insecurity, she explained, goes far beyond food supply. "We produce enough calories, just with cereal crops alone, to feed everyone on the planet," she said. Rather, food insecurity arises from a complex and interactive set of factors including poverty, malnutrition, disease, conflict, poor governance and volatile prices. Food supply depends on limited natural resources including water and energy, and food accessibility depends on government policies about land rights, biofuels, and food subsidies. Often, said Naylor, food policies in one country can impact food security in other parts of the world. Solutions to global hunger must account for this complexity, and for the "evolving" nature of food security.

As an example of this evolution, Naylor pointed to the success of China and India in reducing hunger rates from 70 percent to 15 percent within a single generation. Economic growth was key, as was the "Green Revolution," a series of advances in plant breeding, irrigation and agricultural technology that led to a doubling of global cereal crop production between 1970 and 2010. But Naylor warned that the success of the Green Revolution can lead to complacency about present-day food security challenges. China, for example, sharply reduced hunger as it underwent rapid economic growth, but now faces what Naylor described as a "second food security challenge" of micronutrient deficiency. Anemia, which is caused by a lack of dietary iron and which Naylor said is common in many rural areas of China, can permanently damage children's cognitive development and school performance, and eventually impede a country’s economic growth.

Hunger knows no boundaries

Although hunger is more prevalent in the developing world, food insecurity knows no geographic boundaries, said Naylor. Every country, including wealthy economies like the United States, struggles with problems of food availability, access, and nutrition. "Rather than think of this as 'their problem' that we don't need to deal with, really it's our problem too," Naylor said.

She pointed out that one in five children in the United States is chronically hungry, and 50 million Americans receive government food assistance. Many more millions go to soup kitchens every night, she added. "We are in a precarious position with our own food security, with big implications for public health and educational attainment," Naylor said. A major paradox of the United States' food security challenge is that hunger increasingly coexists with obesity. For the poorest Americans, cheap food offers abundant calories but low nutritional value. To improve the health and food security of millions of Americans, "linking policy in a way that can enhance the incomes of the poorest is really important, and it's the hard part,” she said.” It's not easy to fix the inequality issue."

Success stories

When asked whether there were any "easy" decisions that the global community can agree to, Naylor responded, "What we need to do for a lot of these issues is pretty clear, but how we get after it is not always agreed upon." She added, "But I think we've seen quite a few success stories," including the growing research on climate resilient crops, new scientific tools such as plant genetics, improved modeling techniques for water and irrigation systems, and better knowledge about how to use fertilizer more efficiently. She also said that the growing body of agriculture-focused climate research was encouraging, and that Stanford is a leader on this front.

Naylor is the editor and co-author of The Evolving Sphere of Food Security, a new book from Oxford University Press. The book features a team of 19 faculty authors from 5 Stanford schools including Earth science, economics, law, engineering, medicine, political science, international relations, and biology. The all-Stanford lineup was intentional, Naylor said, because the university is committed to interdisciplinary research that addresses complex global issues like food security, and because "agriculture is incredibly dominated by policy, and Stanford has a long history of dealing with some of these policy elements. This is the glue that enables us to answer really challenging questions." 

 

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From May 13-15, the Center on Food Security and the Environment and the Lenfest Ocean Program welcomed leading Chinese and international scientists to the Stanford Center at Peking University in Beijing, to share research and insights on the role of ocean fisheries, aquaculture, and marine ecosystems for improving food security in China.

Given China’s demographic changes, evolving nutritional requirements, and dominant role in global fisheries, the key question of the symposium was whether marine ecosystems can be managed adequately to support the country’s future vision for domestic food security.

Nearly 30 participants from around the world shared research on the provision of wild fish for direct human consumption and for animal feeds. Participants also shared insights on China’s aquaculture sector, including the tradeoffs involved in using wild fish in aquaculture feed.

Agenda

Session I – Food security and marine ecosystems

Session II – Aquaculture, feeds and fisheries

Session III - Coastal fisheries & impacts on marine ecosystems

Session IV – Economies of the global marine fish trade

Session V - Critical issues and challenges 

Stanford Center at Peking University

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Senior Fellow, Stanford Woods Institute and Freeman Spogli Institute for International Studies
William Wrigley Professor of Earth System Science
Senior Fellow and Founding Director, Center on Food Security and the Environment
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Rosamond Naylor is the William Wrigley Professor in Earth System Science, a Senior Fellow at Stanford Woods Institute and the Freeman Spogli Institute for International Studies, the founding Director at the Center on Food Security and the Environment, and Professor of Economics (by courtesy) at Stanford University. She received her B.A. in Economics and Environmental Studies from the University of Colorado, her M.Sc. in Economics from the London School of Economics, and her Ph.D. in applied economics from Stanford University. Her research focuses on policies and practices to improve global food security and protect the environment on land and at sea. She works with her students in many locations around the world. She has been involved in many field-level research projects around the world and has published widely on issues related to intensive crop production, aquaculture and livestock systems, biofuels, climate change, food price volatility, and food policy analysis. In addition to her many peer-reviewed papers, Naylor has published two books on her work: The Evolving Sphere of Food Security (Naylor, ed., 2014), and The Tropical Oil Crops Revolution: Food, Farmers, Fuels, and Forests (Byerlee, Falcon, and Naylor, 2017).

She is a Fellow of the Ecological Society of America, a Pew Marine Fellow, a Leopold Leadership Fellow, a Fellow of the Beijer Institute for Ecological Economics, a member of Sigma Xi, and the co-Chair of the Blue Food Assessment. Naylor serves as the President of the Board of Directors for Aspen Global Change Institute, is a member of the Scientific Advisory Committee for Oceana and is a member of the Forest Advisory Panel for Cargill. At Stanford, Naylor teaches courses on the World Food Economy, Human-Environment Interactions, and Food and Security. 

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Rosamond L. Naylor Moderator
Symposiums

The Food and Nutrition Policy Symposium Series brings leading experts to Stanford to share new research in an integrated, ten-lecture series on global food and nutrition policy. The series follows on the success of the two-year Global Food Policy and Food Security Symposium Series that concluded in May 2013. We thank Zach Nelson and Elizabeth Horn for their generous support of the symposium series, in honor of Phillip Falcon.

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